Abstract
Objective
To systematically review and examine the current literature regarding the effects
of virtual reality (VR)–based rehabilitation on neural plasticity changes in survivors
of stroke.
Data Sources
We searched 6 bioscience and engineering databases, including Medline via EBSCO, Embase,
PsycINFO, IEEE Explore, Cumulative Index of Nursing and Allied Health, and Scopus.
Study Selection
We selected studies reporting on the pre-post assessment of a VR intervention with
neural plasticity measures published between 2000 and 2021.
Data Extraction
Two independent reviewers conducted study selection, data extraction, and quality assessment. They assessed
methodological quality of controlled trials using the Physiotherapy Evidence Database
scale and evaluated risk of bias of pre-post intervention and case studies using the
National Institutes of Health Quality Assessment Tool.
Data Synthesis
We included 27 studies (n=232). We rated 7 randomized-controlled trials as good quality
and 2 clinical-controlled trials as moderate. Based on the risk of bias assessment,
we graded 1 pre-post study and 1 case study as good quality, 1 pre-post study and
1 case study as poor, and the other 14 studies as fair. After the VR intervention,
main neurophysiological findings across studies include: (1) improved interhemispheric
balance; (2) enhanced cortical connectivity; (3) increased cortical mapping of the
affected limb muscles; (4) the improved neural plasticity measures were correlated
to the enhanced behavior outcomes; (5) increased activation of regions in frontal
cortex; and (6) the mirror neuron system may be involved.
Conclusions
VR-induced changes in neural plasticity for survivors of stroke. Positive correlations
between the neural plasticity changes and functional recovery elucidates the mechanisms
of VR-based therapeutic effects in stroke rehabilitation. This review prompts systematic
understanding of the neurophysiological mechanisms of VR-based stroke rehabilitation
and summarizes the emerging evidence for ongoing innovation of VR systems and application
in stroke rehabilitation.
Keywords
List of abbreviations:
CCT (controlled clinical trial), EEG (electroencephalography), fMRI (functional magnetic resonance imaging), M1 (primary motor cortex), NIH (National Institutes of Health), PFC (prefrontal cortex), PMC (premotor cortex), RCT (randomized controlled trial), S1 (primary somatosensory cortex), SM1 (primary sensorimotor cortex), SMA (supplementary motor area), TMS (transcranial magnetic stimulation), VR (virtual reality)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: August 02, 2021
Accepted:
June 7,
2021
Received in revised form:
June 3,
2021
Received:
February 10,
2021
Footnotes
Disclosures: none.
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
